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Building Code Board of Appeals Application
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W10=
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Applicant's name
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Applicant's phone
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Applicant's street address
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Applicant's city
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Applicant's state
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Applicant's Zip Code
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Name of agent
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Agent's phone
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Agent's street address
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Agent's city
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Agent's state
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Agent's Zip Code
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Property street address
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Parcel or sidwell #
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Reason for appeal
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Date
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Electronic Signature
By typing my name here and submitting this form, I certify that the information provided is true and correct to the best of my knowledge. I understand that my typed name constitutes my electronic signature and has the same force and effect as a handwritten signature.
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